Provider Demographics
NPI:1275335200
Name:WILLIAMS, TIFFANY ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 N CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3018
Mailing Address - Country:US
Mailing Address - Phone:208-250-2162
Mailing Address - Fax:
Practice Address - Street 1:2667 E GALA CT STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2791
Practice Address - Country:US
Practice Address - Phone:208-268-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3871146363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner